If the passing rates on the National Registry of Emergency Medical Technicians’ (NREMT) examinations are an indication of the quality of training being provided to EMT-I and Paramedic students, then congratulations are in order for California’s EMS educators. California is consistently above the average!

At the National Association of State EMS Officials meeting in Little Rock, Arkansas the week of September 21, Bill Brown, Executive Director of NREMT, gave an update on the work of the NREMT and presented each State Training Coordinator attending the meeting a compilation of their state’s passing rate on the NREMT examinations along with the national passing rate for the third quarter of 2009.

For the EMT-Basic examination, the national pass rate is 68% on first attempts and 77% on both the third and sixth attempts, while California weighs in at 75% on first attempts and 79% on third and sixth attempts. For the paramedic examination, the national pass rate is 73% for first attempts, 81% for third attempts, and 82% for sixth attempts while California weighs in at 83% for first attempts and 91% for third and sixth attempts.

Contributing factors to California’s success include the following:

Members of the California Paramedic Program Directors (CPPD) and the California Council of EMS Educators have devoted time, resources, and expertise to the EMS Authority in the development of state policy regarding EMS education. CPPD members have also developed tools for the evaluation of students that have been used statewide and have served on the Educational Technical Advisory Panel to the Commission on EMS.

Since 2004, state law has required paramedic training programs to be nationally accredited by the Commission on Accreditation of Allied Health Education Programs, a requirement supported by the CPPD. A research study conducted by the NREMT has shown that students graduating from an accredited paramedic program consistently score higher on the NREMT paramedic examination than students from non-accredited programs.

California law also requires EMS primary instructors to have at least 40 hours of instruction in teaching methodology, a requirement supported by California’s EMS educators.

California has the highest number of members (286) of any state or country in the National Association of EMS Educators (NAEMSE), a national professional association that provides an opportunity for EMS educators to share insight and information concerning all aspects of EMS education at all levels. The primary purpose of NAEMSE is to meet the wide range of educational needs of the individuals providing instruction to prehospital EMS care providers. California’s EMS educators’ membership in NAEMSE is evidence of their commitment and desire to provide quality education to their students.

The EMS Authority appreciates the efforts of California’s EMS educators to ensure there are well-trained, highly qualified emergency medical care providers ministering to the ill and injured in California’s prehospital environment.

Novel H1N1 Influenza A Virus activity continues to be widespread in California. During the week of September 20-26, 252 hospitalizations, including 14 deaths, were reported to the California Department of Public Health (CDPH). There have been 2,510 hospitalizations including 188 fatalities reported in California since the virus was discovered.

The best tool for reducing the risk of contracting H1N1, besides staying away from sick people and washing hands, is to get vaccinated. This is a huge undertaking for public health officers when almost everyone is vulnerable to the disease. Especially considering that the vaccine hasn’t even been available until now and the flu season is fully upon us.

In coordination with the federal government, CDPH began allocating the first doses of H1N1 vaccine to all 61 local health jurisdictions this week. California will receive approximately 350,000 doses of vaccine in the first round, and will likely exceed 22 million doses this season. As of now, our local partners are implementing their plans for the largest vaccination effort since the polio vaccination programs of the 1950s.

In some areas, the bottleneck in quickly vaccinating the public may be having enough qualified people available to administer the vaccines. In order to assist in getting target groups vaccinated as quickly as possible, paramedics may be needed to extend the capability of local public health vaccination programs.

Although vaccinations are not within the basic scope of practice for paramedics, the Director of the Emergency Medical Services Authority, upon request of the LEMSA Medical Director, has the ability to approve a local optional scope of practice to include vaccinations under local medical control and as part of the organized emergency medical system.

Dr. Steve Tharratt, EMSA Director, has determined that rather than issue a statewide blanket inclusion, he will review and approve requests for vaccination by paramedics on an individual LEMSA basis upon request of the local medical director. The request includes the target population planned for vaccination by paramedics, an overview of the community vaccination plan, and policies and procedures for:

procurement, handling, storage and administration of the vaccine;

health screening of individuals to be vaccinated;

documentation of the clinical and demographic information;

medical control, treatment protocols, and quality assurance; and

additional training of paramedics to administer vaccine.

As of October 5, EMSA has approved six temporary expanded scope of practice requests. These approvals will expire in July 2010. “So far, local medical directors are requesting a very limited vaccination authority for paramedics,” Tharratt said. “Most are seeking to enable paramedics to vaccinate other emergency responders.”

Ensuring that paramedics have the skill and knowledge necessary was paramount for EMSA. Certainly paramedics are trained to give intramuscular injections, practice infectious disease control, and be aware of adverse reactions, but there are other things to be aware of in administering vaccinations. A “Just-In-Time” training presentation was developed for use by the local agencies that covers:

public health principles for infectious diseases and influenza;

general principles of vaccinations;

a drug profile of the vaccine including drug name, classification, action, indication, contraindications, routes of administration, dose and side effects; and

documentation procedures for vaccine administration.

“The LEMSA’s are especially appreciative of the training presentation because it is saving them a lot of work as they prepare for this new role,” said Dan Smiley, Chief Deputy Director of EMSA. “We tried to make it brief – it can be delivered in a couple of hours – but still ensure that paramedics who may end up giving vaccinations are completely prepared for the task.” The just-in-time training materials may be found on the department’s H1N1 website at www.emsa.ca.gov/Media/Default/PPT/H1N1JustInTimeParamedicVaccineTraining09-13-2009.ppt.

Commission on Emergency Medical Services September 2009 Meeting

The Commission on Emergency Medical Services gathered for its quarterly meeting Wednesday, September 23 at the Doubletree Club Hotel in San Diego. Members met from 10 a.m. to 1 p.m. to receive project updates from Emergency Medical Services Authority (EMSA) staff and to take action on a number of items requiring Commission consent or direction.

The meeting began with a report by EMSA Director Dr. Steve Tharratt, who introduced the newest Commission member, Dr. Dev Gnanadev. Gnanadev is Chief of Surgery at Arrowhead Regional Medical Center and current president of the California Medical Association. He was appointed to the Commission by the Senate Rules Committee in June.

Dr. Tharratt gave an overview of the second California Trauma System Summit held onsite that week, noting the great progress achieved over the past year as well as the enthusiasm for continuing the work. He addressed the significant fiscal crisis facing the California Poison Control System and updated Commissioners on ongoing efforts to secure additional funding through a partnership with the Managed Risk Medical Insurance Board (Healthy Families Program). Dr. Tharratt also discussed changes to regional EMS Agencies, including the recent moves of Butte County EMS and Colusa County EMS from Northern California EMS, Inc. to the Sacramento-Sierra Valley EMS Agency.

Regarding the H1N1 Novel Influenza virus, Dr. Tharratt introduced a comprehensive “just-in-time” training presentation developed by EMSA staff and local jurisdictions for use in training paramedics to give vaccinations, and discussed the process LEMSAs will use to apply for a temporary optional scope of practice for that purpose.

Alameda County Fire Chief Sheldon Gilbert, who is president of the California Fire Chiefs Association and a member of the Commission on Emergency Medical Services, presented a California Fire Service position paper on EMS statutory roles and responsibilities. The paper was a collaborative effort between the California Fire Chiefs Association, the League of California Cities Fire Chiefs’ Department, and the California Professional Firefighters. It outlines the history of conflict due to differing interpretations of statutes by local EMS agencies regarding 911 dispatch, EMS services and provider agreements and makes recommendations for regulatory clarification and a dispute resolution process. On Dr. Tharratt’s suggestion, the Commission recommended that EMSA convene a workshop to explore the issue in early 2010.

Dr. Angelo Salvucci, Medical Director for the Santa Barbara County EMS Agency, gave a presentation on his trial study of ondanestron (Zofran) for nausea in prehospital and interfacility transfer settings. The Commission recommended that the Director approve the drug for the paramedic local optional scope of practice.

Updates were provided on other EMSA programs including the EMT 2010 Project(Broken Link), which will be a significant focus of the next Commission meeting, as well as the status of private EMS training programs, California EMS Information System (CEMSIS) training sessions, the Stroke/STEMI System, the Air Medical Transport Task Force, the Regional Disaster Medical Health Coordinators, and the 12th Annual EMS for Children Conference scheduled for November. Written copies of the reports and further information about all of these programs is available in the Commission Meeting Agenda.

The Commission also reviewed and discussed the new Tactical Medicine Guidelines developed by EMSA and the Commission on Police Officer Standards and Training (POST). POST has approved the guidelines and the EMS Commission will vote on them at their next meeting.

The next EMS Commission meeting will be held December 2, in San Francisco at the Marines’ Memorial Club and Hotel. This will be an all-day meeting as Commissioners will take up regulation packages related to the EMT 2010 Project. A full agenda will be available on the EMS Commission website at least 10 days prior to the meeting. For more information, contact Robin Robinson at robin.robinson@emsa.ca.gov.

California Trauma System Summit II: Improving Trauma Care through Statewide Trauma System Development

By Johnathan Jones, RN, BSN

About a year ago California’s trauma constituents met at the first California Statewide Trauma System Summit empowering Regional Trauma Coordinating Committees (RTCCs). The charge of the RTCC revolved around uniting the various trauma systems to form the “System of Systems.” Over the next year, the RTCCs met and addressed regional triage criteria, gap analysis, repatriation, funding, and RTCC structure. The RTCCs outlined their success, struggles, and vision during the California Statewide Trauma System Summit II in San Diego on September 21, 2009.

“There is a lot to celebrate here,” said Dr. Steve Tharratt, Director of the Emergency Medical Services Authority (EMS Authority). “We have come such a long way in coordinating our efforts to improve care for the critically injured patient.”

The State Trauma Advisory Committee, Chaired by Dr. David B. Hoyt, chose the summit format because it facilitated the seamless collaboration between the audience, consisting of more than 250 trauma stakeholders and trauma experts, with the speakers and panelists.

Summit II, hosted by the University of California, San Diego Trauma Department, commenced with a range of presentations expressing local to international perspectives of trauma care, displaying a roadmap of trauma history, and introducing stakeholder expectations for future trauma care in California. Panel discussions included pediatric best practices, creative funding, and progress reports from the Regional Trauma Coordinating Committees.

Dr. Robert Mackersie and Dr. A. Brent Eastman harnessed the vision of the group and identified next steps. Steps identified include (1) establishing a structured relationship for the RTCCs with the LEMSAs and the State EMS Authority; (2) profiling best practices of the RTCCs; (3) implementing a trauma registry with all of the LEMSAs; (4) writing an inclusive trauma plan; and (5) involving non-trauma hospitals in a statewide trauma system. On September 23, 2009, Dr. R. Steven Tharratt, Director of the EMS Authority, appointed five additional members to the State Trauma Advisory Committee to specifically represent the RTCCs. The EMS Authority seeks to build a collaborative trauma system plan through the State Trauma Advisory Committee and the RTCCS.“There was definitely a commitment to continue moving the statewide trauma system forward,” said Dr. Tharratt. “The participants showed a palpable enthusiasm for that outcome and the EMS Authority very much looks forward to continuing to build upon the success of this partnership.”

We all realize that EMS personnel are a vital and integral part of the emergency medical services team. First responders are trained to provide stabilizing and lifesaving care to our citizens. The duties that EMS personnel perform are usually done as a matter of routine, and they receive little recognition for activities that are “above and beyond” the call of duty, much less for a job well done. It is for this reason that the Emergency Medical Services authority initiated an EMS Awards Program.

Dan Smiley, Chief Deputy Director of the EMS Authority, stated, “The EMS Awards Program is an excellent showcase to acknowledge and honor the selfless, courageous, and often times life saving acts these extraordinary emergency personnel perform on a daily basis.”

The awards presentation for the 2008 nomination period will take place on December 2 at the Marines’ Memorial Club and Hotel in San Francisco during the regular EMS Commission meeting. Awards that will be handed out include: EMS Administrator of the Year, EMS Medical Director of the Year, EMT of the Year, the Medal of Valor, and the Life Saving Medal aka Recognition of Clinical Excellence.

The review committee is comprised of members of the California Ambulance Association, the California Fire Chief’s Association, the Emergency Medical Directors Association of California, the Emergency Medical Services Administrators’ Association of California, and the San Francisco Paramedics Association.

EMS providers, supervisors, and managers are encouraged to watch for outstanding performances by their staff, and to nominate any responsible individual for recognition in the appropriate category. For additional information and nomination forms please go to the EMSA website at www.emsa.ca.gov.

San Francisco Paramedics Association Educational Conference

The San Francisco Paramedics Association hosted a two-day conference September 24-25 at Saint Mary’s Conference Center in San Francisco. This event focused on the continuum of care from the pre-hospital setting to the emergency department. It also provided an excellent opportunity for local EMS responders to network with friends and colleagues and see state-of-the art equipment and technology.

The conference included a wealth of educational presentations on such topics as airway management, chest trauma, pediatric trauma, advanced waveform capnography, cardiac arrest, shock, and stroke. Personnel attending the conference earned 14 continuing education credits for attending the two day conference.

Dr. Steve Tharratt, Director of the Emergency Medical Services Authority, addressed the crowd with information about recent and upcoming activity at the state level. He provided a thorough update on the EMT 2010 Project implementing legislation that requires an EMT registry and background checks. He also spoke about the H1N1 influenza virus and its potential impact on EMS, as well as the progress being made at the state level to mitigate the risk to individuals and the additional burden on health care resources.

Regional Disaster Medical / Health Specialists: Having the Right People in Place Before a Disaster Makes the Difference

by Patrick Lynch, RN

More than two decades ago, the Regional Disaster Medical Health Specialist (RDMHS) concept was developed by the Emergency Medical Services Authority (EMSA) to provide staff for the Regional Disaster Medical Health Coordinator. The concept of providing trained people who would devote all of their time to planning for a disaster was still gaining acceptance. It has since evolved into a successful program with a host of accomplishments that now serves as a model for other agencies.

RDMHSs provide day-to-day planning and coordination of medical and health disaster response in the state’s six mutual aid regions and assist in developing the plans, procedures and infrastructure of California’s medical/health mutual aid system. The program is funded jointly between EMSA and the California Department of Public Health to improve medical and health emergency response.

Their functions are directed by EMSA and the supporting Local Emergency Medical Services Agency. They include management and improvement of regional medical and health mutual aid and mutual cooperation systems; coordination of medical and health resources; and support of the State medical and health response system.

“RDMHSs are valuable partners who perform key disaster-related medical and health functions,” said Jeff Rubin, who oversees this program and others as Chief of Disaster Medical Services Response at EMSA. “They play a critical role in situation reporting to ensure a statewide, coordinated response to fires and other natural and technological emergencies.”

In several recent wildland/urban interface fires including the widespread 2007 San Diego firestorms, last year’s Paradise Fire in Butte County and the recent fire in Santa Barbara, RDMHSs coordinated resource support to the impacted areas. This assistance included: Ambulance Strike Teams with EMSA Disaster Medical Support Unit for patient care and transportation; public health nurses and physicians for community care; and disaster medical managers for Emergency Operations Center response coordination.

In their preparedness role, RMDHSs have participated in the development of the California Disaster Medical Operations Manual and Interim California Disaster Health Operations Manual which are key components of California’s medical and public health emergency preparedness and response program. Several RDMHSs participate in national-level committees to improve the country’s public health and medical Emergency Support Function #8 including key elements of the National Disaster Medical System (NDMS) Disaster Medical Assistance Teams (DMATs) program.

“They lead the way in the development of standardized, statewide disaster medical and health situation reporting and resource requesting tools as part of SEMS,” said Rubin.

Currently, six local EMS Agencies serve as RDMHS contractors to the EMS Authority and each have hired a staff member to serve the counties within their mutual aid region.

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